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Can prostate treatment be worse than the disease?

by Loren Bonner, DOTmed News Online Editor | April 09, 2013
The American College of Physicians, one of the largest medical organizations in the U.S., added to the rhetoric on Monday when it came out with new recommendations for men considering prostate cancer screening.

Taking a more middle-of-the-road approach, ACP guidance encourages men between the ages of 50 and 69 to discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer. The PSA test is a blood test that might indicate prostate cancer is present.

The United States Preventive Services Task Force caused an uproar in late 2011 when it recommended against PSA screening, concluding that the harm outweighed any benefit. ACP recommendations do suggest this test might not benefit most men and could even do more harm than good.

"PSA testing is a problem because it is less accurate than we had hoped. Potentially you go forward with surgery for a relatively benign cancer that may never cause problems," said Dr. David Bronson, president of ACP.

Every year, roughly 30 million men undergo PSA testing, but the test is not an accurate measure because many of the cancers it detects are unlikely to cause harm. Therefore, men who test positive proceed with radiation treatment or surgery, leaving them at risk for complications such as sexual dysfunction and urinary incontinence.

"That's the balance problem you have — that sometimes the treatment is worse than the disease," said Bronson.

ACP's new guidance statement, published in the April 9 issue of Annals of Internal Medicine, also includes talking points for doctors to help them explain the benefits and harms of prostate cancer screening and treatment.

ACP recommends against the PSA test for average-risk men under the age of 50, men older than 69 and men who have a life expectancy of less than 10 to 15 years because the harms of prostate cancer screening outweigh the benefits. The new recommendations were based on a review of all the available guidelines and evidence to date.

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